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It's an isekai manga, and not a reincarnation manga. There are elements of romance but I wouldn't call it a romance manga.

I distinctly remember it starts with the main character in a school setting. There was a girl that was interested in him, and was about to confess to him but got interrupted as he was experiencing severe headaches. He then got transported to a new world.

There was a scene where he was on an operation table and was possibly being experimented on. This may have been how he got his powers from whoever summoned him.

I forget at which point, but he met a tiny fairy/pixie who he befriends, who is later suggested to become the main heroine and love interest for the MC. She can change sizes and I remember she was shown to be very proficient in magic when she is in her larger form.

I don't remember much else other than the MC having to do guild quests with his magic powers in this fantasy land filled with other monsters.

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The source is Kuro no Maou by Hishikage, Dairi (Story) and Matoba, Ryou (Art).

Front cover of Kuro no Maou

Kurono Maou is a high school student who is sensitive to his sharp eyes and bad expression. With no girlfriend, but gifted with friends in his own way, he had been living a peaceful life. One day, without any reason, Kurono was attacked by a mysterious headache while in the literature clubroom and fainted. When he finally awoke...swords and magic, filled with monsters, an orthodox different world summoning.

Funnily, I found it 5 minutes later I posted the question. Just had to surf the tags without the "adaptation" tag, even though it is a web novel adaptation.

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    Don't forget to accept in two days. And congrats on finding it!
    – FuzzyBoots
    Oct 19, 2022 at 12:24

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